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General NPI Number Information
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NPI Number | 1740360742
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Entity Type | Individual
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Provider Name | JIM ROLAND CABALLERO O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 12661 GLENOAKS BLVD
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City | SYLMAR
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State | CA
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Zip | 91342-4748
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Country | US
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Telephone | 818-367-2171
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Fax |
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Provider Business Mailing Address
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Address Line | 28523 APPLEWOOD LN
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City | CASTAIC
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State | CA
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Zip | 91384-4339
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Country | US
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Telephone | 661-295-9443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8936T
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License Number State | CA
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